Authorization Representative

KabaFusion•Edison, NJ

2d•$22 - $28

About The Position

This position is responsible for ensuring patients continue care without delay by securing accurate insurance verification, required authorizations, and complete start‑of‑care documentation. This position protects revenue integrity, supports clean claims, and ensures compliance while coordinating effectively with patients, payers, and internal teams in alignment with the organization’s mission and operational goals.

Requirements

High school diploma or equivalent education.
Minimum of two (2) years in home infusion or fast-paced health care environment
Proficient experience with Microsoft Office including Word, Excel, and Teams, and/or electronic health care record software system preferred.
Knowledge of HCPCS/CPT codes, authorization submission processes, and insurance coverage requirements, including Medicare, Medicaid, and commercial plans, with familiarity in medical terminology and billing pricing methodologies.
Strong problem-solving skills with the ability to proactively research, analyze, and resolve issues independently, demonstrating initiative and sound judgment.
Proficiency in learning and working with internal company platforms, including billing, authorization, and patient management systems.
Ability to work independently with minimal supervision while effectively prioritizing, multitasking, and meeting goals and deadlines, as well as collaborating successfully with cross-functional teams.
Demonstrated accuracy in calculating pricing quotes and authorization lengths using approved units and days, coupled with effective communication skills when interacting with patients, clinical teams, and corporate departments.

Responsibilities

Provides courteous and professional telephone support to patients, families, referral sources, payors, and clinical staff.
Verifies insurance coverage prior to deliveries to ensure accuracy, active coverage and notifies internal departments and patients of any policy changes or benefit terminations.
Ensures services to be provided are eligible and covered under the patient’s insurance benefits.
Ensures accurate and timely completion of start‑of‑care, Financial Obligation, and Medicare/Medicaid forms and coordinates prompt distribution to the Pharmacy and Nursing Departments via electronic or postal delivery.
Collects, verifies, and documents insurance cost‑share and authorization details, including coinsurance, copays, deductibles, and requirements.
Tracks authorization needs and expirations and secures authorization for ongoing patient care to prevent missed administration of medication.
Provides timely notification to internal stakeholders, prescribers, and patients regarding authorization approvals, issues, or delays in care.
Accurately estimates patient financial responsibility by applying insurance verification information, payer contracts, and self‑pay policies.
Coordinates and documents patient start‑of‑care materials, creating additional documentation on a timely basis as needed to support compliant service delivery.
Ensures complete and accurate documentation of eligibility, authorization, and communications within the electronic medical record.
Assists with analyzing and resolving insurance claim rejections to support timely and accurate reimbursement.
Protects patient health information by following regulations for HIPAA compliance
Other related duties as assigned by manager or designee.